1. California Elder Abuse Summit Presentation by William F. Benson Health Benefits ABCs April 29, 2010

2. Elder Rights & the OAA A Rich Long History From enactment in 1965 the OAA established high expectations for its network of federal, state and local agencies – they were given the mandate to serve as "effective and visible" advocates on behalf of older Americans.

3. Elder Rights & the OAA A Rich Long History SUAs to “serve as an effective and visible advocate for older individuals by reviewing and commenting upon all State plans, budgets, and policies which affect older individuals and providing technical assistance to any agency, organization, association, or individual representing the needs of older individuals” (OAA Sec. 305(a)(1)(D))

4. Elder Rights & the OAA A Rich Long History AAAs to “serve as the advocate and focal point for older individuals within the community by (in cooperation with agencies, organizations, and individuals participating in activities under the plan) monitoring, evaluating, and commenting upon all policies, programs, hearings, levies, and community actions which will affect older individuals” (OAA Sec. 306(a)(6)(B)

5. Elder Rights & the OAA A Rich Long History “serve as an effective and visible advocate” language for AoA: -- Assistant Secretary shall (1) “serve as the effective and visible advocate for older individuals within the Department of Health and Human Services and with other departments, agencies, and instrumentalities of the Federal Government by maintaining active review and commenting responsibilities over all Federal policies affecting older individuals”

6. Elder Rights & the OAA A Rich Long History “serve as an effective and visible advocate” language for AoA: -- Director of Office of LTCOPs will “serve as an effective and visible advocate on behalf of …” -- Director of Office of AIANNH will “serve as the effective and visible advocate in behalf of older individuals who are Native Americans…”

7. Elder Rights & the OAA A Rich Long History 1970s AoA funded: -- Nursing Home Ombudsman Demonstration (transferred from PHS to AoA in 1975) -- Number of national legal/law-related demonstration programs (e.g., National Paralegal Institute) -- SUAs with advocacy assistance grants to support state level development in both ombudsman and legal assistance services. -- Bi-Regional Advocacy Assistance Centers

8. Elder Rights & the OAA A Rich Long History Long-Term Care Ombudsman Program added to the OAA following demo program (1978 Amendments) -- 1981 amendments add board & care responsibility -- 1987 amendments – major for the LTCOP (e.g., “analyze & monitor the development & implementation of Federal, State, and local laws, regulations…recommend any changes in such laws, regulations, and policies deemed by the Office to be appropriate”)

9. Elder Rights & the OAA A Rich Long History Legal Services/Assistance -- Legal Services Developers (initially had to be attorneys) -- 1970s-1980s – expansion of legal assistance under Title III & tensions with aging network & with LSC - 1987 Amendments: Neither a state, nor a state agency nor an AAA “may require any provider of legal assistance under this title to reveal any information that is protected by the attorney-client privilege.”

10. Elder Rights & the OAA A Rich Long History “Prevention of Abuse, Neglect, & Exploita- tion of Older Individuals” program added to OAA as new Part G of Title III by ‘87 amendments (Rep. Mary Rose Oakar) -- Grants to states -- Prevention activities & referrals to others (e.g., law enforcement, APS, LTCOP) -- “Trigger” language re appropriations

11. Elder Rights & the OAA Title VII “Vulnerable Elder Rights Protection” – 1992 Amendments -- AoA described Title VII as,"...a powerful new tool to assist vulnerable older people to exercise their rights and secure the benefits to which they are entitled. It provides a framework upon which States can build a coordinated, integrated, statewide system of advocacy and assistance for such older people. Based on Title VII, states will be able to establish a single focal point for OAA programs and activities which are primarily advocacy oriented..."

12. Elder Rights & the OAA Title VII Subtitle A Initially consisted of 5 chapters: -- Ch 1 – General State Provisions (State Plan Requirements) -- Ch 2 – Ombudsman Programs -- Ch 3 – Prevention of Elder Abuse, Neglect & Exploitation -- Ch 4 – State Elder Rights & Legal Assistance Development -- Ch 5 – State Outreach, Counseling, and Assistance Program for Insurance & Public Benefits

13. Elder Rights & the OAA Title VII Why create Title VII? -- Emphasis on state-level -- Emphasis on protecting rights of older individuals -- Strengthening of individual programs -- Emphasizing coordination among programs/services Why not direct legal assistance services?

14. Elder Rights & the OAA Other Provisions Title II -- NORC -- NCEA -- Various Demonstration Programs (e.g., P & A, Housing Ombudsman)

15. Elder Rights & the OAA Appropriations History

16. OAA appropriations: Title III (in thousands) FY 1993FY 2000 FY 2003 FY 2010 93-10 $ 93-10 % Supp. Serv. $313,708$310,082$355,673$368,348+$54,640+17% Home meals $89,659$146,970$180,985$217,676+$128,017+143% Cong. meals $363,236$374,336$384,592$440,783+$77,547+21% OAA Total $1,372,700$1,513,048$1,784,469$2,341,722+$969,022 +70% Source: CRS Report for Congress: Older Americans Act: History of Appropriations, FY1966-FY2004 FY 2011 Administration on Aging Justification of Estimate for Appropriations Committees FY 2010 appropriations conference report, H.Rept. 111-366

17. OAA appropriations: Title VII (in thousands) FY 1993FY 2000 FY 2003 FY 2010 93-10 $ 93-10 % Ombud sman $3,870n/s $16,827+$12,957+335% Prev. abuse $4,348n/s $5,056$708+16% Title VII $8,218$13,181$18,559$21,883+$13,665+166% OAA Total $1,372,700$1,513,048$1,784,469$2,341,722 +$969,022+70% n/s= not specified Source: CRS Report for Congress: Older Americans Act: History of Appropriations, FY1966-FY2004 FY 2011 Administration on Aging Justification of Estimate for Appropriations Committees FY 2010 appropriations conference report, H.Rept. 111-366

18. Elder Justice Act “Lovers of Sausage and the Law Should Watch Neither Made”

19. Source: Congressional Research Service

20. Number of Components in the Elder Justice Act  H.R. 3490, Subtitle H, Sec. 6701  Authorized for FY 2011-2014  Amends Title XX of the SSA (Sec. 2011 & following) – Finance Committee & Ways & Means  Only portion of original version of EJA (note Sestak’s Elder Abuse Victims Act of 2009)  9 Major Distinct Components (& Definitions)

21. Number of Components in the Elder Justice Act (2)  13 Distinct Authorizations of Funding – Need Annual Appropriations – Otherwise, “Close but no cigar”  “Such Sums”  Varying amounts per FY  Fixed authorizations for some provisions – e.g., APS grants to states  Heavily LTC-focused XXX  Who Will Administer/Implement?  AoA?  CMS?  Secretary?  Other?

22. EJA Component Parts  Elder Justice Coordinating Council – all feds  Authorization – such sums  Advisory Board on EAN & E – 27 public members  Authorization – such sums  Research Guidelines re human subject protections  Authorization -- $6.5 M then $7.0 M  Forensics Centers (4 Stationary Centers, 6 Mobile Centers)  Authorization -- $4M FY 11 (to $8 M)

23. EJA Component Parts  Enhancement of Long-Term Care  Grants & Incentives for LTC Staffing (Career Ladders, Wage & Benefit Increases, Technology, Adoption of Standards for Transactions re Clinical Data)  Authorization -- $20M FY 11 (drops to $15 M in FY 13-14)  Protecting Residents of LTC Facilities  National Training Institute for Surveyors (with National Complaint Intake System)  Authorization -- $12 M FY 11-14  Grants to State Survey Agencies re complaint investigations systems  Authorization -- $5M FY 11-14

24. EJA Component Parts  Reporting to Law Enforcement of Crimes Occurring in Federally Funded LTC Facilities (to Secretary & Law Enforcement)  Includes owners, operators, employees, managers, agents, contractors of LTC facilities  CMPs for failure to do so  Additional Penalties for Retaliation  No Appropriation

25. EJA Component Parts  National Nurse Aide Registry  Study & report to Coordinating Council & Congress – 18 mos.  Congress (Finance, W&Ms, E&C) “shall, as they deem appropriate, take action on the recommendations  Authorization – such sums Evaluation Evaluation No AppropriationNo Appropriation “Tap” – not less than 2% appropriated for each program“Tap” – not less than 2% appropriated for each program

26. EJA Component Parts – LTC Ombudsman Grants & Training Grants to States Grants to States Improve capacity of LTCOPs to respond to/resolve complaints about abuse & neglect Improve capacity of LTCOPs to respond to/resolve complaints about abuse & neglect Pilot programs with state & local ombudsman entities Pilot programs with state & local ombudsman entities National support (e.g., Nat’l LTCO Resource Center) National support (e.g., Nat’l LTCO Resource Center) Authorizes $5 million in FY 08, $7.5 million in FY 09 & $10 million in FY 10 & FY 11 Authorizes $5 million in FY 08, $7.5 million in FY 09 & $10 million in FY 10 & FY 11 Ombudsman Training Programs re elder abuse, neglect & exploitation – authorized at $10 million for FY 2008-2011 Ombudsman Training Programs re elder abuse, neglect & exploitation – authorized at $10 million for FY 2008-2011

27. What the EJA means for Adult Protective Services (APS) First dedicated federal funding for APS First dedicated federal funding for APS $100 million in new money to states for APS $100 million in new money to states for APS $25 million in new money for APS demo grants $25 million in new money for APS demo grants $3-4 million for HHS for a federal “home” for APS $3-4 million for HHS for a federal “home” for APS

28. What the EJA means for APS: A “Federal Home” ► Establish functions with respect to Adult Protective Services (APS) to be administered by the Secretary to provide leadership to the states’ programs. Authorizes $3m FY 11 & $4m FY 12-14 ► Functions include providing funding and support to state and local adult protective services offices that investigate reports of abuse, neglect and exploitation of elders and vulnerable adults; collecting and disseminating information on abuse in coordination with the Department of Justice; developing and disseminating information on best practices; conducting research and providing technical assistance to states that provide or fund protective services.

29. What the EJA means for APS: State Funding Adult Protective Service Grant Program (State Formula Grants) -- Use of Funds Adult Protective Service Grant Program (State Formula Grants) -- Use of Funds ► Authorizes $100 million ► Funds may be used only by states and local governments to provide adult protective services & may only be used for APS. ► State receiving funds would be required to provide these funds to the agency or unit of state government having legal responsibility for providing adult protective services in the state. ► Each state would be required to use these funds to supplement and not supplant other federal, state, and local public funds expended to provide adult protective services. ► California: $9.958 milllion =170 FTEs (at $60,000 each)

30. What the EJA means for APS: National Demonstration Grants State Adult Protective Service Grants (Demonstration Program) – Authorizes $25 million State Adult Protective Service Grants (Demonstration Program) – Authorizes $25 million “Would require the Secretary to establish grants to states for adult protective service demonstration programs. Funds may be used by state and local units of government to conduct demonstration programs that test: training modules developed for the purpose of detecting or preventing elder abuse; methods to detect or prevent financial exploitation and elder abuse; whether training on elder abuse forensics enhances the detection of abuse by employees of state or local government; and other related matters. States would be required to submit applications to the Secretary.”

31. Implementation of the EJA ► “Show me the money” (“Jerry Maguire) – the battle & challenges for appropriations  Significance for APS ► Who will be responsible for what at HHS? ► What is the timetable especially sans appropriations – e.g., no action taken until appropriations? ► Those items not requiring appropriations – e.g., reporting of crimes in LTC facilities

32. Appropriations ► Advocacy needed by all of you: ► California has a lot of members on the Appropriations Committees (full & Labor, HHS Subs) – but all members needed – see www.elderjusticecoalition.com www.elderjusticecoalition.com ► Importance of APS funds – new money to states ► Your Governor’s Office (& national orgs) ► California Legislature (& national orgs) ► State orgs – e.g., C4A & CWDA (Nat’l reps)

33. Appropriations – Past as Prologue? ► The Track Record ► Congress (and States) ► Aging Network ► Elder Abuse Victims – just another client group? ► OAA Reauthorization  “Be bold” notion  Pick right vehicles (e.g. APS & OAA)  Pyrrhic victories – little sustained joy

34. Congratulations National Adult Protective Services Association Elder Justice Coalition Health Benefits ABCs 11101 Georgia Ave., #320 Silver Spring, MD 20912 301-933-6492tbcg@starpower.net

35. This Affects All Generations